High Anxiety

Q: I am 21 years old and have recently began experiencing high anxiety and panic. This has never happened to me before and it started out small and is getting worse. I think it's all in my head, and when I think about or talk about panic, it makes it worse. When I am at work I get nervous and scared for no reason and driving makes me very nervous depending on how far I commute. I don't know what to do. I need some suggestions and tips that I can do myself to relax because I have no insurance and cannot afford private therapy. I would deeply appreciate any advice. Thank you.Freaking Out

A: Dear Freaking Out,First, take heart because you're in swell company with millions of other Americans who suffer panic attacks. I commend you for taking positive steps now to address your symptoms.

You are right to say that it's all in your head. Panic disorder is a game that your mind plays with you, and you have to outsmart it. The fact is that panic attacks live off your fear of them. That's why just thinking about them can send you into one. Let's look briefly at the components of panic.

Anxiety is an evolutionary development that helped our hunting-and-gathering ancestors survive. When you go into panic mode, also known as fight-or-flight mode, a number of physiological changes take place. Blood rushes from your head to your extremities, resulting in dizzyness, light-headedness, and/or feeling "unreal" or "otherworldly." Your breathing becomes shallow, resulting in a sense of "breathlessness." These are helping you to fight or flee a life-threatening situation. Many people become sweaty; the moisture makes us slippery and difficult for a predator to grasp. The thing to remember here is that anxiety was designed to save us, not hurt us.

Today, we aren't in the literal jungle anymore, but our physiology hasn't caught up. Hence, many people get a small flash of dizzyness or shallow breathing and interpret that they are having a heart attack. Others feel a rush of adrenaline and feel "out of this world," and interpret those sensations as "going out of my mind." They fear they might lose control and run around wildly killing strangers. Others may first have a disturbing "cognitive intrusion" or thought and begin to feel the physiological sensations. In any event,all of these misinterpretations only increase the anxiety and, voila, you have yourself in a panic attack.

The most successful treatment I have used in my practice is symptom induction. In this technique, the client will try to bring on their most disturbing physiological (not psychological) symptoms 3-5 times per day, or when they are starting to have a panic attack. The idea here is not to scare yourself, but rather to try to make your heart pound for about 10 seconds, make yourself feel dizzy for a bit, and so forth. This is a desensitization technique that has worked miracles for many.

This technique is part of cognitive-behavioral therapy treatment for panic disorder. Other essential elements are cognitive restructuring to help you reinterpret events and sensations more realistically.

Another bit of insight: A large majority of my clients with panic disorder exhibit a lack of assertiveness in their interpersonal relationships. I had noted this anecdotally for some time, but now there is research supporting this.

Finally, I would encourage you to visit this wonderful web site from the Centre for Clinical Interventions and the Department of Health in Western Australia, Panic Stations. This is a goldmine. It is a free set of 12 self-help modules for panic attacks, and it's free!
Be well,
Michael